Single or double embryo transfer?

I'm nowhere near a transfer yet, but if all goes well (and I pray it does), I feel like this is a question I need to have a ready answer to. Single or double embryo transfer?

Here are my ponderings on the subject: I am planning on going to grad school in May 2017 (a year from now). This program is rigorous and doesn't allow for any time off, which means once I get in, I can't be pregnant. Which means a baby should ideally come before or after. The program also has a teratogenic component in the 2nd and 3rd years (which means, I can't be TTC (trying to conceive) during that time).

If this IVF (in vitro fertilization) cycle is successful, my EDD (estimated due date) would be in March, which gives me 2-3 months of medical leave and then I would go to school 2-3x/week for the first year, then 5-6x/week for 2nd and 3rd years.

I've never wanted twins, simply because I'm an introvert, and feel that I would bond/be able to give more to one child at a time. But now, there is a part of me that A) wants to have a complete family asap, B) wants to increase the odds of success C) doesn't want to go through the headache of the unknown years down the line.

However, I am nervous about the potential of twins, mostly from a medical perspective, but also the logistics - will it be too much while persuing doctorate level education? From a medical perspective, I only know of one person personally who has had twins, and she had to be on bedrest the second half of her pregnancy.

I am curious to see what everyone's reasons are for transfering one or two, what thought process you went through.

Also, please disregard the play-by-play of my life. Things have yet to work out the way I plan them out. But I never learn.

My blunt 2 cents: Transferring two to complete your family in one shot or to just hope one sticks is the wrong reason to transfer two. You should only transfer two if you are 100% happy with the thought of twins should that be the outcome. It would not be fair to your children to have twins when you really only wanted one child at a time.

Here are the reasons I'm transferring one CCS/PGS tested embryo, though it's a highly person decision.

My history of loss, I'm under 35, the many, MANY risks associated with pregnancy of multiples for mother and babies, stress, finances, childcare, and my mental/physical/emotional ability to parent two at once...

My blunt 2 cents: Transferring two to complete your family in one shot or to ...

Posted
05/14/2016

My blunt 2 cents: Transferring two to complete your family in one shot or to just hope one sticks is the wrong reason to transfer two. You should only transfer two if you are 100% happy with the thought of twins should that be the outcome. It would not be fair to your children to have twins when you really only wanted one child at a time.

I'm ok with the idea of twins. It just wasn't something I ever thought about before we started experiencing difficulties ttc. I don't have any history of twins in my family, so I always assumed I would have one at a time. For that reason, it's an idea I'm still warming up to, though at the end of the day I just want IVF (in vitro fertilization) to work. But it is a relevant question now, because the odds go up significantly with two and because it's so expensive. These aren't all pretty thoughts, but it's the reality of the process.

I said two, mainly because at this point there's no guarantees. If you transfer two, you could get:

-0
-1
-2
-3
-4 or more

If you just want it to work, you will have to become comfortable with the idea that it could involve more than one and that you will be able to figure it out as you go. I don't think most of us ever had to think about twins or more, but if the goal is a THB then we end up doing a lot of things we didn't ever "plan" on!

I assume you will be able to keep the embryos frozen until you're done with your program if it didn't work? Your program sounds interesting, by the way!

In some ways it's hard to make a decision until you have embryos. It also depends if you do pgs. If you have two high quality pgs, you probably don't want to transfer two unless you're truly comfortable with twins. If you have multiple low quality embryos pgs or not, two may be a better option - you'll still risk twins but the lower quality will make it less likely for either to stick.

Also I'd be cautious about having such a strict timeline on when you can and can't be pregnant. Ivf unfortunately often doesn't run according to your timeline. I'm sure you know this but it's hard to truly get until it happens. I am a textbook perfect case for likely ivf success and I've had three egg retrievals and gotten one crappy quality pgs normal embryo each time. Ivf may work perfectly for you the first time and you'll have lots of embryos to choose from but it may not - even if you look like someone who'd be great at it.

Another thing to consider is your comfort level with triplets. It's highly unlikely but embryos do split and we've had people on this board who implanted two and got three. So you need to consider whether you're willing to handle triplets or whether you'd selectively reduce.

In some ways it's hard to make a decision until you have embryos. It also...

Posted
05/14/2016

In some ways it's hard to make a decision until you have embryos. It also depends if you do pgs. If you have two high quality pgs, you probably don't want to transfer two unless you're truly comfortable with twins. If you have multiple low quality embryos pgs or not, two may be a better option - you'll still risk twins but the lower quality will make it less likely for either to stick.

Also I'd be cautious about having such a strict timeline on when you can and can't be pregnant. Ivf unfortunately often doesn't run according to your timeline. I'm sure you know this but it's hard to truly get until it happens. I am a textbook perfect case for likely ivf success and I've had three egg retrievals and gotten one crappy quality pgs normal embryo each time. Ivf may work perfectly for you the first time and you'll have lots of embryos to choose from but it may not - even if you look like someone who'd be great at it.

Another thing to consider is your comfort level with triplets. It's highly unlikely but embryos do split and we've had people on this board who implanted two and got three. So you need to consider whether you're willing to handle triplets or whether you'd selectively reduce.

Thanks for your insight.

Yes, a lot of these things will become clear once I have the embryos on hand and know what kind of quality we are dealing with. After all, I am unexplained... I don't know much about pgs. I did inquire about it during my consultation, but my RE (reproductive endocrinologist) said he woudln't recommend it right away.

As for the timeline, I completely share your sentiments. As I said in my original post, things have yet to work out the way I plan them out. I am still under the illusion that because my partner and I are both healthy, IVF (in vitro fertilization) has to work. Logically, I know it might not, but for my own sanity, and until further notice, I believe it will.

At the end of the day, having a baby comes first, so if we see success later on in the year, I will postpone school by a year. At the same time, I have already postponed or cancelled many things over the years because I thought "I would be pregnant then", so I am trying to live life normally and make plans as I normally would.

Triplets are a harder pill to swallow. Though I would be ok if there was a guarantee of a healthy outcome for all, I am terrified of the complications involved for the babies.

If you are specific about wanting only one and in a timeline that can work for you, I'd highly recommend pgs testing. The success rates for single embryo transfers with it are very high. So I'd look more into it. Good luck with your program though. I totally understand intensive post graduate training with risk. You can make the program and ivf work. We women are strong like that!

Bump. Curious if anyone else has an opinion. I'm still dealing with my demons on this topic. And yes, I get it, I may have no embryos at all, but one can dream... and I feel the need to be prepared for every possible scenario. Every day is different and one day I seem to imagine my one "perfect" child (at about 5 years old, walking hand in hand with me and hubby), and other days, I imagine a beautiful family of four... or six. I had a chance to talk to a few more people who've had twins and they reassured me that pregnancy is unpredictable (i.e. twins can go to term, and a singleton can have delays, depending on the stiuation...)

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